Homework assignments in psychoanalysis are contentious; some believe they contradict psychoanalytic principles, while others argue they enhance coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient’s experience and that homework may be an important component of treating personality disorders. We present the case of a man diagnosed with narcissistic personality disorder to illustrate this: the patient, wrestling with social relations and control dynamics within therapy, was assigned homework aimed at curbing his compulsive caregiving and exploring its underlying motives. This exercise led him to understand his actions stemmed from avoidance of exposing his vulnerabilities. Subsequently, he was able to engage with relationships from diverse perspectives and discover new meanings. We advocate that homework tasks can be successfully incorporated into the relational psychoanalytic approach, fostering self-reflection and facilitating transformative change in patients with personality disorders.

The present study expands on previous research regarding the correlation between parental overprotection (POP) and non-suicidal self-injury (NSSI) in Chinese adolescents. Drawing from self-determination theory, the study aims to investigate the mediating effect of psychological need satisfaction on the relationship between POP and adolescent NSSI, as well as the potential moderating effect of anger expression. A sample of 1248 adolescents (Mage = 13.34 years; SD = 0.96 years) completed anonymous questionnaires to measure the study variables. The results of the regression analysis indicate that: (1) the positive link between POP and adolescent NSSI is mediated by low psychological need satisfaction; (2) this indirect relationship is particularly pronounced in adolescents who report high levels of anger expression. These findings suggest that psychological need frustration may serve as a mechanism linking POP to adolescent NSSI, and that adolescents who tend to express more anger may be at an increased risk for engaging in NSSI. Systemic family therapy is recommended for clinicians and consultant to help them better understand the adolescents with NSSI in overprotective family system and adopt targeted intervention programs.

EFT is an empirically supported treatment of depression for individuals, and is also considered to be an integrative, transdiagnostic therapy approach focusing on emotions that are the cause of a client's emotional pain and suffering. The target of treatment is to facilitate emotional processing to change unhealthy emotion schemes that underlie current symptoms of depression. The therapist is highly attuned to the client's moment-by-moment process to promote in-session work on emotion, alongside experiential teaching. In-session work is consolidated and expanded by between-session homework, which is viewed as a natural extension of the in-session work. EFT views the therapist as an emotion coach who offers interventions within a client's developmental and experiential learning capabilities to move them to their end goals. A case example is discussed to illustrate how homework is used effectively in treating a depressed client in relation to treatment principles over the course of treatment.

Objectives: Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. Method: Participants ( N =246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: Distress (composed of depression, generalized anxiety, irritability, and panic symptoms); Fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and Bipolar (mania and obsessive-compulsive). Results: During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed Distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed Fear. Conclusion: It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.

Objective: A qualitative study sought to understand the transition experiences of United States (U.S.) military Service members found “unfit for duty” following medical and physical evaluation boards (MEBs and PEBs). Methods: Confidential telephone interviews were conducted with 25 current and prior Service members. Participants were asked to share their experiences before, during, and after the MEB and PEB processes. To that end, interview questions were designed to gather the following types of transition experiences: (1) health conditions experienced during the medical disability evaluation process; (2) reactions to being recommended for separation, (3) transition-related stress and challenges, and (4) coping strategies. Salient themes were identified across chronological narratives. Results: Conditions that participants’ experienced included debilitating physical (e.g., injury) and/or mental health (e.g., post-traumatic stress disorder) conditions. In response to the “unfit for duty” notice, some participants reported emotional distress (e.g., anxiety, sadness, anger) connected to a sense of uncertainty about the future. Other participants reported relief connected to a sense of progression toward their medical disability claim status. Transition stress included the length of the MEB/PEB process, impact of the COVID-19 pandemic on the process, experiences of financial stress, impact on family life, and the compounded effect of these stressors on emotional distress, including depression and suicidal thoughts. Participants reported using adaptive (e.g., psychotherapy) and maladaptive (e.g., excessive drinking) strategies to cope with stress. Conclusions: The notable emotional distress and transition stress experienced by Service members found “unfit for duty” highlight the need for increased support and interventions to facilitate adaptive coping strategies during this vulnerable period.

Objective: Interpersonal difficulties are salient among those with a history of NSSI and precede NSSI urges and behaviors. Yet, limited research has focused on identifying which aspects of interpersonal stress may confer risk for NSSI. Method: The current study aimed to leverage data from two samples (combined n=206; n=114 with NSSI history) of participant-driven interviews regarding a recent interpersonal stressor to enhance the field’s knowledge of interpersonal difficulties in relation to NSSI risk. Results: Using topic modeling to extract thematic information, analyses identified four main topics: daily difficulties; family members; adjectives/verbal fillers; and friendship/romantic relationships. Relationships between the topics and three predictors (i.e., NSSI history, emotion dysregulation, sample) were examined. In one sample, the proportion of ‘adjectives/verbal fillers’ was greater for participants with a NSSI history and at higher levels of emotion dysregulation. Across samples, for participants with a NSSI history, ‘adjectives/verbal fillers’ and ‘friendship/romantic partners’ increased with levels of emotion dysregulation. Conclusion: Findings highlight a greater use of adjectives and verbal fillers among individuals with a history of NSSI and higher levels of emotion dysregulation. This pattern of language may serve as an indicator of a specific aspect of emotion regulation difficulties that confers risk for NSSI.

Background Misophonia is often characterized by excessive negative emotional responses, including anger and anxiety, to “trigger sounds” which are typically day-to-day sounds, such as those generated from people eating. Misophonia (literally ‘hatred of sounds’) has commonly been understood within an auditory processing framework where sounds cause distress due to aberrant processing in the auditory and emotional systems of the brain. However, recent evidence from brain imaging shows involvement of the motor system while listening to trigger sounds suggesting that the perception of an action (e.g., mouth movement) produced by a trigger person, not the sound per se, drives distress in misophonia. Observation or listening to sounds of another’s actions are known to prompt automatic mimicry/imitations. Apart from anecdotal evidence and a few case studies, a relationship between mimicry and misophonia has not been evaluated. Method We addressed this ‘gap’ by collecting data on misophonia symptoms and mimicry behaviour using online questionnaires from 676 participants. Results The analysis shows, (i) the tendency to mimic varies in direct proportion to misophonia severity assessed using a self-reported questionnaire, (ii) compared to other human and environmental sounds, trigger sounds of eating and chewing are more likely to trigger mimicking, and (iii) the act of mimicking provides relief from distress to most people with misophonia. Conclusion Mimicry is widely prevalent in misophonia and is elicited by the most common trigger sounds of eating. The data provides support to the model that misophonia is not a disorder of sound-processing but rather its basis lies in social perception.

Objective: Intrusive thoughts are characterized by a sense of intrusiveness of foreign entry into cognition. While not always consisting of negative content, intrusive thoughts are almost solely investigated in that context. Involuntary Musical Imagery (INMI) offers a promising alternative, as it is a type of involuntary cognition that can be used to evaluate intrusiveness without negative content. Methos: In Study 1, 200 participants completed self-report questionnaires to assess several aspects of intrusiveness: meta-awareness, control, repetitiveness, frequency, and subjective experience of INMI. In Study 2, 203 participants completed self-report questionnaires to explore the clinical characteristics (depression, stress, anxiety, and rumination) which might mediate the connection between INMI frequency and INMI negative experience. Results: Study 1 revealed, through exploratory factor analysis, that intrusiveness shares variance with the negative experience of INMI but not with INMI frequency. In study 2, ruminative thinking was found to mediate the relationship between frequent INMI and negative experience of INMI. Conclusion: These results suggest that INMI might be used to investigate intrusiveness in the lab without the potential confound of negative emotions. In addition, the results suggest that neither the content nor the frequency of intrusive thoughts can solely explain why these thoughts are aversive to some but not others. Ruminative style might be the missing link to explain how and why these intrusive thoughts become aversive and obsessive. In other words, we suggest that the cause for intrusiveness lies not in the thought or repetitiveness, but in the thinker.

Background Bipolar disorder (BD) is a severe mental illness characterised by recurrent manic, hypomanic and depressive episodes alternating with euthymic periods. The burden of BD is vast, and many patients have unmet needs in their treatment. To better support patients in their personal recovery and well-being, positive psychology interventions (PPIs) have shown to be a promising tool. Recently, a mobile application has been developed to offer PPIs: the WELLBE BD-app. Aim The current study was designed to study the acceptability of the WELLBE BD-app and evaluate the feasibility of the design for use in a larger controlled trial (CT). We also studied the potential effects on mental health. Method This pilot-study used a mixed-methods quantitative and qualitative approach in which participants were randomly assigned to an intervention- or a treatment-as-usual control group, each with 20 participants with BD. The study sample consisted of a seven weeks during intervention. To assess acceptability, we held semi-structured interviews in the intervention group and collected log data and questionnaire data on the actual use of the app and perceived value of the accompanying exercises. Feasibility was determined by the number of completers of the intervention in both the intervention and control groups. Potential effects on mental health outcomes were measured using an extensive set of pre and post-intervention questionnaires. Results The intervention was fully completed by 52.7% (n = 11) of the participants and partly completed (1 to 4 modules) by 37.8% (n = 8). The post-test response rate was 73% in both groups. On average, the exercises were rated with a value of 7.5 on a scale of 1 to 10 ( SD = 1.2). Users found the application easy to use, useful for people with BD, and to have an attractive design. Problems with installation, technical problems, and lack of support were barriers to using the app. Guidance by an expert by experience (in videos before the exercises) was preferred by 80% of the participants instead of guidance by a professional. Effects on mental health outcomes were small and statistically non-significant, both between- and within groups. Although we found no significant results in the quantitative part of our study, the qualitative results show that people with BD appreciated the content and design of the intervention. The minimal effects on mental health may be partly explained by the small sample size and the relatively high levels of mental health of the participants at baseline. Conclusions and Implications for Practice Based on this study a larger trial on the effects of the WELLBE-app appears feasible and warranted. Next to minor modifications based on this pilot study, to create optimal impact including patients with lower levels of well-being is recommended and the guidance by experts or peers needs to be considered.

Objective: Although life stress and adversity have emerged as risk factors for mental health problems and cognitive impairment among older adults, prior studies on this topic have been cross-sectional and based on relatively homogeneous samples. To address these issues, we examined prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the U.S. Method: We analyzed data from the Health and Retirement Study (1992-2016). The sample included 3,496 individuals (59.9% female), aged ≥64 years old (M age=76.0 ±7.6 years). We used the individual-level panel data and ordinary least squares regressions to estimate associations between childhood and adulthood adversities and later-life depression, anxiety, and cognitive impairment. Results: Many participants experienced a significant early life (38%) or adulthood (79%) stressor. Second, experiencing a childhood adversity was associated with a 17.4% increased risk of experiencing an adulthood adversity. Finally, childhood and adulthood adversities both prospectively predicted more symptoms of late-life depression, anxiety, and cognitive impairment. Discussion: These findings are among the first to demonstrate prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in older adults. Screening for lifetime stressors may thus help health care professionals and policymakers identify individuals who could benefit from interventions designed to reduce stress and enhance resilience.

Complex PTSD (CPTSD) is a new diagnosis in the World Health Organization (WHO)’s International Classification of Diseases (ICD-11). This case study describes the delivery of Skills Training in Affective and Interpersonal Regulation and Narrative Therapy (SNT), a flexible, multi-component therapy that addresses the symptoms of CPTSD. SNT balances interventions that address current day stressors with those that reappraise the meaning of traumatic past events. This paper outlines 16 sessions of SNT with a 55-year-old gay man. The treatment introduces client tailored coping skills for current minority stress, discrimination and micro-aggressions as well as trauma-focused interventions regarding events from his childhood and the death of his partner and many members of his community due to the AIDS epidemic. Qualitative and quantitative outcomes are summarized. Implications regarding the relevance of SNT for sexual and gender minority (SGM) individuals is discussed.